| NPI | 1013570472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005982) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001401A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 135.001030) | |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2022-08-15 |